The patient presents to the emergency department with altered mental status and myoclonic jerking. Although the nurse notes that the patient is flushed and his face is red, his skin and mucous membranes are dry and warm to the touch. The nurse also notes decreased bowel sounds and palpates a distended bladder. Vital signs are significant for a temperature of 39.9°C (103.8°F), heart rate of 122 bpm and a blood pressure of 165/92 mm Hg. The nurse prepares to administer which of the following medications to this patient?

Question

The patient presents to the emergency department with altered mental status and myoclonic jerking. Although the nurse notes that the patient is flushed and his face is red, his skin and mucous membranes are dry and warm to the touch.  The nurse also notes decreased bowel sounds and palpates a distended bladder. Vital signs are significant for a temperature of 39.9&deg;C (103.8&deg;F), heart rate of 122 bpm and a blood pressure of 165/92 mm Hg. The nurse prepares to administer which of the following medications to this patient?

Accepted Answer

Physostigmine. The patient is exhibiting signs of anticholinergic toxicity. Physostigmine is the recommended antidote. Ipecac syrup should be avoided for GI decontamination due to increased risk of aspiration with altered mental status. Oxybutynin is an anticholinergic medication; therefore, it is contraindicated in this patient. Morphine sulfate may further slow bowel function and should be avoided.

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